Antidepressants

[androjello]

I'm guessing Effexor at doses >150 mg's could be added to the list of drugs that raise seratonin and norepinephrine?

[Cryptochid]

Ive been on every anti dep for over a 25 year period. The worse side effect is lack of sexual arrousal and erectile dysfunction. I found the sustanon shots left me with the equivelant of "that time of the month" issues amongst women.

The adroderm for me was useless - depression was constant and my GP suggested anti deps while on androderm, but when I started pallets, the depression completely resolved itself. Have touched anti deps since last August, probably due the the "constant" secretion of T.

I did notice when my free T dropped of after 4 months with pallets, depression started to kick in. I only had the depression return for one week as another "insert" was done.

Would like to know what SWALE thinks about the link of free T and depression

[Albert]

Thank YOU marianco,

The more I read about these drug and there use, the more I think our GP's and Primary Care Physicians should not be handing these out like kids candy.

Every time I see my doctor and we end up not doing anything about my problems, the more they pushed anti-depressants on me.

The drug companies must be making a killing from the drugs.

In the past when I have tried these drugs they have knocked me around and all I want to do is sleep, 24/7.

No thanks, my brain is already stuffed from the other drugs they said would help.

Later,
Albert.

[marianco]

Originally Posted by Cryptochid

Ive been on every anti dep for over a 25 year period. The worse side effect is lack of sexual arrousal and erectile dysfunction.

I found the sustanon shots left me with the equivelant of "that time of the month" issues amongst women.

The adroderm for me was useless - depression was constant and my GP suggested anti deps while on androderm, but when I started pallets, the depression completely resolved itself. Have touched anti deps since last August, probably due the the "constant" secretion of T.

I did notice when my free T dropped of after 4 months with pallets, depression started to kick in. I only had the depression return for one week as another "insert" was done.

Testosterone Pellets generally would be third in line behind Depot-Testosterone injections and Transdermal Testosterone because of the additional risks of a surgical procedure, and (for myself) dependence on the physician (whereas with the other options, one can administer testosterone to oneself).

However, when the first two options fail for various reason, the testosterone pellets may be a good idea.

The improved level of Free Testosterone is an interesting finding - and possible benefit of the pellets versus injections and transdermal route.

I wonder if an attempt to increase Free Testosterone when using injections or testosterone cream/gel by using substances that reduce estrogen levels - which then reduces sex hormone binding globulin - which is what binds testosterone, reducing free testosterone.

I wonder if a high enough dose of depo-testosterone or transdermal testosterone was used to help increase Free Testosterone levels. Testosterone can be compounded at higher concentrations (such as 10% Testoscreme) using absorption accelerants other than alcohol to improve absorption and possibly effectiveness.

I wonder how depression correlates with dihydrotestosterone levels (DHT) in addition to Free testosterone. If depression improves with higher DHT levels, then a testosterone cream can be placed on scrotal skin to achieve higher DHT levels than at other locations.

[marianco]

Originally Posted by Albert

The more I read about these drug and there use, the more I think our GP's and Primary Care Physicians should not be handing these out like kids candy. Every time I see my doctor and we end up not doing anything about my problems, the more they pushed anti-depressants on me.

Antidepressants are highly useful. However, they do not solve every problem. They have a difficult time treating depression when a different neuroendocrine imbalance not addressed by the antidepressant is the cause (e.g. testosterone, estrogen, progesterone, cortisol insufficiency). And, if the physician is not aware of all the profound effects antidepressants can have, problems can arise.

[earthdog]

Doctor, a few more questions if you will.

Out of the SSRIs you mention, do you have a particuar favorite? Maybe one you start with?

In your experience, do any of the SSRIs mentioned above cause memory loss? How about Wellbutrin (not an SSRI, I know)?

Are you aware of any memory loss problems related to Effexor?

Thanks again.

[marianco]

Serotonin Reuptake Inhibitors (SSRIs) are very complex medications. The primary mechanism of action is to block serotonin reuptake (causing an increase in serotonin). However, they also block norepinephrine reuptake, block dopamine reuptake (increasing dopamine), reduce dopamine production, act directly on serotonin 2C receptors, block acetylcholine receptors, inhibit nitric oxide synthetase, block liver enzymes including 2D6, 3A4 or 1A2, etc. Each SSRI does these things to a varying extent. However, even if weak on one mechanism, I do not discount it because I may and have met patient who were sensitive to a mechanism of action, causing side effects, when the textbooks would say it should not.

Reducing dopamine levels or blocking acetylcholine can lead to memory problems. Each SSRI has the potential to impair memory depending on the genetic response of the person taking it.

In general, I prefer SSRIs which tend to have less weight gain as a problem. Obesity causes so many neuroendocrine problems that impair treatment (e.g. excess estrogen activity, insulin resistance, impaired self-esteem, etc.), that I prefer minimizing weight gain as a side effect. Cosmetically, women and men prefer to avoid weight gain strongly. I use to have patient who would gain 20-30 pounds while on an SSRI, and losing weight would be difficult. The ones which are less likely to cause weight gain are Lexapro and it's "mother", Celexa. However, I keep the other ones in mind, because depending on the person, he or she may respond better to the other ones (Prozac, Paxil CR, Paxil, Zoloft, Luvox) for the intended purpose of treatment.

Wellbutrin (regular, SR, XR), works primarily as a norepinephrine reuptake inhibitor (not dopamine reuptake inhibitor). It is almost a pro-drug in that its metabolite is a much more potent norepinephrine reuptake inhibitor than Wellbutrin itself, and is concentrated more in the brain than Wellbutrin itself. Memory impairment, in my experience, is much less frequent with Wellbutrin than the SSRIs. It may help improve attention - thus help improve memory - in people with attentional problems. "Your mileage may vary" as the statement goes.

I have not heard of memory loss as a problem with Effexor. It is more potent than the SSRIs at increasing dopamine levels, thus possibly compensating for the reduction in dopamine from blocking serotonin reuptake. However, at about 150 mg a day and below, it primarily acts as a serotonin reuptake inhibitor, and thus may have similar risks for memory problems - depending on individual response to the treatment.

There is no perfect antidepressant. Depending on the severity of life stresses, a response to any individual antidepressant can vary from 17-70 percent. Response means a 50% reduction in symptoms of depression. Patients with severe stress respond most poorly to antidepressants because the stress can overwhelm treatment. Often a multiple-medication treatment is needed to adequately reduce the severity of symptoms.

Treatment has to be customized for the person - taking into account genetics, symptoms, the nature of the illness, previous response to treatment, health problems, side effects and interactions to avoid, etc. It is an art since we do not yet have specific testing for brain status and function which partain specifically to mental illness. Since there is no perfect antidepressant, I have to maintain an open mind about what may help a patient.

[chap]

Is there hope (or reason) to get a person off of ssri treatment, after they have been on for years and are convinced they need it? Is it just wishful thinking on behalf of a loved one to think there must be a better way?

[Albert]

Thank you marianco, you write so eloquently and express your opinion with the patients interests in mind.

May I ask what are your thoughts on, when you're prescribing drugs, do you look at the effects of the drugs verses the quality of life issues of the patient. Do you place quality of life high on the list or are you just interested in what the drug does.

The reason I ask is, some of the drugs I have been give in recent times, either make me to dopey to lead a normal life and/or total ED and etc. and my doctor is not interested in my quality of life issues.

Thanks,
Albert.

[marianco]

Originally Posted by chap

Is there hope (or reason) to get a person off of ssri treatment, after they have been on for years and are convinced they need it? Is it just wishful thinking on behalf of a loved one to think there must be a better way?

If something is working for a person, why stop it?

Unless there definitely is a "better way", why stop what is currently working?

SSRIs are highly useful medications. They save lives.

Major depressive disorder or other mental illness can be devastating to a person.

The risk of death from major depressive disorder is approximately between 15 to 50% depending on what other comorbid conditions there are. It is thus a high risk to stop treatment that is working.

One's loved ones cannot know truly how it feels or what hell a person is experiencing unless they themselves had a similar depression.

The prospect of returning to depression if one stops the solution - in this case an antidepressant - is a good reason for many people to continue their medications.

Major depressive disorder - like many illnesses - once developed and recurrent (meaning it has a tendency to return) - is a lifelong illness and needs to be treated in a lifelong way, just as hypogonadism, once developed should be looked at with a lifelong perspective.

Unless there is a better answer (i.e. works better, definitely fewer side effects than the current medication regimen), I would not attempt a switch.